Complications from influenza and pneumonia claim about 100,000 lives in the U.S. each year. "Opt-out" standing order vaccination programs implemented in hospitals can significantly reduce the number of patients who should be immunized but are not. With an opt-out program, nurses or pharmacists follow a hospital-established protocol to screen and vaccinate hospitalized patients for influenza or pneumonia without a physician's direct examination or order -- unless the patient's physician overrides the order or the patient refuses.

Opt-out programs improve vaccination rates more effectively than other institution-based strategies, said Joseph L. Dorsey, M.D., Harvard Vanguard's director of inpatient services at Brigham and Women's Hospital and Faulkner Hospital, one of 11 Massachusetts hospitals that has adopted the program.

"So-called 'opt-in' policies, where a reminder pops up on the hospital's computer screen if a patient is due for an immunization, result in vaccination rates of only 35 to 40 percent of eligible inpatients, whereas 'opt-out' policies typically deliver an 80 to 90 percent vaccination rate," noted Dr. Dorsey.

According to the Massachusetts Hospital Association (MHA), up to 46 percent of influenza-related hospitalizations occur among elderly people who were previously hospitalized for non-flu-related reasons during that flu season. And up to two-thirds of patients hospitalized with serious pneumococcal infections had been hospitalized at least once within the previous three to five years.

The CDC's Advisory Committee on Immunization Practices (ACIP) recommends standing order programs. The state's Department of Public Health, MHA, MMS, and MassPRO are working together to have 95 percent of hospitals in Massachusetts adopt opt-out programs by May 2005.

The ACIP recommends that hospitals implementing opt-out programs establish protocols to identify vaccine-eligible patients; educate nursing staff, patients and families; record patient refusals or contraindications; administer vaccine; monitor adverse events; and update vaccination records for patients and their physicians.

The hospital's medical executive committee, which is made up primarily of physicians, is responsible for establishing the protocols, said Dr. Dorsey.

"Whether or not your hospital implements opt-out, remember to give your patients flu shots -- and get one yourself," concluded Dr. Dorsey. "You don't want to be the vector for your own patients."

- Robyn Alie
- Jamay Liu

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